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Do carotid artery calcifications seen on radiographs predict stenosis in asymptomatic adults?
EVIDENCE SUMMARY
Mixed results, quality issues do not support screening asymptomatic patients
A meta-analysis (12 observational studies; n = 1002) compared the diagnostic accuracy of
In a retrospective cohort study (n = 778) from the United States, researchers identified carotid artery calcifications on routine dental radiographs in patients ≥ 55 years old and prospectively performed duplex ultrasound (DUS) to assess for significant carotid stenosis (≥ 50%).2 Twenty-seven patients (3.5%) had carotid artery calcifications on radiographs, and 20 of those patients underwent DUS of bilateral carotid arteries (40 sides). Of 26 sides with calcifications on radiograph, 13 (50%) had stenosis confirmed with DUS. Of the 14 sides without calcification on radiograph, 3 (21%) had stenosis on DUS. The positive predictive value for calcification on PR predicting significant carotid stenosis was between 40% and 80%.
In a cross-sectional study from Sweden, investigators sought surgical candidates for asymptomatic carotid endarterectomy and performed PRs of 1182 patients.3 Calcifications were found in 176 people; 117 of them were eligible for asymptomatic carotid endarterectomy (ages 18-74; no cancer or other serious comorbidity; and no prior stroke or transient ischemic attack) and underwent ultrasound to assess for significant carotid stenosis (≥ 50%). Of the 117 participants who underwent ultrasound, 8 (6.8%; 95% CI, 2.2%-11.5%), all men, were found to have significant carotid stenosis. Compared to a sex- and age-matched reference group (n = 119) with no calcifications on PR, the prevalence of carotid stenosis was significantly higher in men (12.5%; 95% CI, 4.2%-20.8%) and in patients who were current smokers (19%; 95% CI, 0.7%-37.4%), were taking cholesterol medications (13.1%; 95% CI 4.4%-21.8%), and had a cardiovascular event history (15.9%; 95% CI, 7%-27.2%).
Recommendations from others
The US Preventive Services Task Force (USPSTF) and the American Academy of Family Physicians do not mention carotid screening with radiographs but recommend against
Editor’s takeaway
If you see calcification of the carotid artery on an x-ray of an asymptomatic patient, ignore it. The positive and negative predictive values for carotid stenosis are poor, and you should not pursue further testing.
1. Schroder AGD, de Araujo CM, Guariza-Filho O, et al. Diagnostic accuracy of panoramic radiography in the detection of calcified carotid artery atheroma: a meta-analysis. Clin Oral Investig. 2019;23:2021-2040. https://doi.org/10.1007/s00784-019-02880-6
2. Almog DM, Horev T, Illig KA, et al. Correlating carotid artery stenosis detected by panoramic radiography with clinically relevant carotid artery stenosis determined by duplex ultrasound. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94:768-773. doi: 10.1067/moe.2002.128965
3. Johansson EP, Ahlqvist J, Garoff M, et al. Ultrasound screening for asymptomatic carotid stenosis in subjects with calcifications in the area of the carotid arteries on panoramic radiographs: a cross-sectional study. BMC Cardiovasc Disord. 2011;11:44. doi: 10.1186/1471-2261-11-44
4. USPSTF. Carotid artery stenosis: screening. Updated February 2, 2021. Accessed September 1, 2021. www.uspreventiveservicestaskforce.org/uspstf/recommendation/carotid-artery-stenosis-screening
5. American Academy of Family Physicians. Don’t screen for carotid artery stenosis (CAS) in asymptomatic adult patients. Choosing Wisely website. Published February 21, 2013. Accessed August 29, 2020. www.choosingwisely.org/clinician-lists/american-academy-family-physicians-carotid-artery-stenosis/
EVIDENCE SUMMARY
Mixed results, quality issues do not support screening asymptomatic patients
A meta-analysis (12 observational studies; n = 1002) compared the diagnostic accuracy of
In a retrospective cohort study (n = 778) from the United States, researchers identified carotid artery calcifications on routine dental radiographs in patients ≥ 55 years old and prospectively performed duplex ultrasound (DUS) to assess for significant carotid stenosis (≥ 50%).2 Twenty-seven patients (3.5%) had carotid artery calcifications on radiographs, and 20 of those patients underwent DUS of bilateral carotid arteries (40 sides). Of 26 sides with calcifications on radiograph, 13 (50%) had stenosis confirmed with DUS. Of the 14 sides without calcification on radiograph, 3 (21%) had stenosis on DUS. The positive predictive value for calcification on PR predicting significant carotid stenosis was between 40% and 80%.
In a cross-sectional study from Sweden, investigators sought surgical candidates for asymptomatic carotid endarterectomy and performed PRs of 1182 patients.3 Calcifications were found in 176 people; 117 of them were eligible for asymptomatic carotid endarterectomy (ages 18-74; no cancer or other serious comorbidity; and no prior stroke or transient ischemic attack) and underwent ultrasound to assess for significant carotid stenosis (≥ 50%). Of the 117 participants who underwent ultrasound, 8 (6.8%; 95% CI, 2.2%-11.5%), all men, were found to have significant carotid stenosis. Compared to a sex- and age-matched reference group (n = 119) with no calcifications on PR, the prevalence of carotid stenosis was significantly higher in men (12.5%; 95% CI, 4.2%-20.8%) and in patients who were current smokers (19%; 95% CI, 0.7%-37.4%), were taking cholesterol medications (13.1%; 95% CI 4.4%-21.8%), and had a cardiovascular event history (15.9%; 95% CI, 7%-27.2%).
Recommendations from others
The US Preventive Services Task Force (USPSTF) and the American Academy of Family Physicians do not mention carotid screening with radiographs but recommend against
Editor’s takeaway
If you see calcification of the carotid artery on an x-ray of an asymptomatic patient, ignore it. The positive and negative predictive values for carotid stenosis are poor, and you should not pursue further testing.
EVIDENCE SUMMARY
Mixed results, quality issues do not support screening asymptomatic patients
A meta-analysis (12 observational studies; n = 1002) compared the diagnostic accuracy of
In a retrospective cohort study (n = 778) from the United States, researchers identified carotid artery calcifications on routine dental radiographs in patients ≥ 55 years old and prospectively performed duplex ultrasound (DUS) to assess for significant carotid stenosis (≥ 50%).2 Twenty-seven patients (3.5%) had carotid artery calcifications on radiographs, and 20 of those patients underwent DUS of bilateral carotid arteries (40 sides). Of 26 sides with calcifications on radiograph, 13 (50%) had stenosis confirmed with DUS. Of the 14 sides without calcification on radiograph, 3 (21%) had stenosis on DUS. The positive predictive value for calcification on PR predicting significant carotid stenosis was between 40% and 80%.
In a cross-sectional study from Sweden, investigators sought surgical candidates for asymptomatic carotid endarterectomy and performed PRs of 1182 patients.3 Calcifications were found in 176 people; 117 of them were eligible for asymptomatic carotid endarterectomy (ages 18-74; no cancer or other serious comorbidity; and no prior stroke or transient ischemic attack) and underwent ultrasound to assess for significant carotid stenosis (≥ 50%). Of the 117 participants who underwent ultrasound, 8 (6.8%; 95% CI, 2.2%-11.5%), all men, were found to have significant carotid stenosis. Compared to a sex- and age-matched reference group (n = 119) with no calcifications on PR, the prevalence of carotid stenosis was significantly higher in men (12.5%; 95% CI, 4.2%-20.8%) and in patients who were current smokers (19%; 95% CI, 0.7%-37.4%), were taking cholesterol medications (13.1%; 95% CI 4.4%-21.8%), and had a cardiovascular event history (15.9%; 95% CI, 7%-27.2%).
Recommendations from others
The US Preventive Services Task Force (USPSTF) and the American Academy of Family Physicians do not mention carotid screening with radiographs but recommend against
Editor’s takeaway
If you see calcification of the carotid artery on an x-ray of an asymptomatic patient, ignore it. The positive and negative predictive values for carotid stenosis are poor, and you should not pursue further testing.
1. Schroder AGD, de Araujo CM, Guariza-Filho O, et al. Diagnostic accuracy of panoramic radiography in the detection of calcified carotid artery atheroma: a meta-analysis. Clin Oral Investig. 2019;23:2021-2040. https://doi.org/10.1007/s00784-019-02880-6
2. Almog DM, Horev T, Illig KA, et al. Correlating carotid artery stenosis detected by panoramic radiography with clinically relevant carotid artery stenosis determined by duplex ultrasound. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94:768-773. doi: 10.1067/moe.2002.128965
3. Johansson EP, Ahlqvist J, Garoff M, et al. Ultrasound screening for asymptomatic carotid stenosis in subjects with calcifications in the area of the carotid arteries on panoramic radiographs: a cross-sectional study. BMC Cardiovasc Disord. 2011;11:44. doi: 10.1186/1471-2261-11-44
4. USPSTF. Carotid artery stenosis: screening. Updated February 2, 2021. Accessed September 1, 2021. www.uspreventiveservicestaskforce.org/uspstf/recommendation/carotid-artery-stenosis-screening
5. American Academy of Family Physicians. Don’t screen for carotid artery stenosis (CAS) in asymptomatic adult patients. Choosing Wisely website. Published February 21, 2013. Accessed August 29, 2020. www.choosingwisely.org/clinician-lists/american-academy-family-physicians-carotid-artery-stenosis/
1. Schroder AGD, de Araujo CM, Guariza-Filho O, et al. Diagnostic accuracy of panoramic radiography in the detection of calcified carotid artery atheroma: a meta-analysis. Clin Oral Investig. 2019;23:2021-2040. https://doi.org/10.1007/s00784-019-02880-6
2. Almog DM, Horev T, Illig KA, et al. Correlating carotid artery stenosis detected by panoramic radiography with clinically relevant carotid artery stenosis determined by duplex ultrasound. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94:768-773. doi: 10.1067/moe.2002.128965
3. Johansson EP, Ahlqvist J, Garoff M, et al. Ultrasound screening for asymptomatic carotid stenosis in subjects with calcifications in the area of the carotid arteries on panoramic radiographs: a cross-sectional study. BMC Cardiovasc Disord. 2011;11:44. doi: 10.1186/1471-2261-11-44
4. USPSTF. Carotid artery stenosis: screening. Updated February 2, 2021. Accessed September 1, 2021. www.uspreventiveservicestaskforce.org/uspstf/recommendation/carotid-artery-stenosis-screening
5. American Academy of Family Physicians. Don’t screen for carotid artery stenosis (CAS) in asymptomatic adult patients. Choosing Wisely website. Published February 21, 2013. Accessed August 29, 2020. www.choosingwisely.org/clinician-lists/american-academy-family-physicians-carotid-artery-stenosis/
EVIDENCE-BASED ANSWER:
Not very well. In asymptomatic patients, carotid artery calcification seen on radiograph has a positive predictive value of 70% and a negative predictive value of 75% for carotid artery stenosis (strength of recommendation [SOR]: B, systematic review of observational studies with heterogeneous results and a retrospective cohort study). Carotid calcifications on radiographs may be more predictive of carotid stenosis in people with atherosclerotic risk factors (SOR: C, cross-sectional study). Harms outweigh benefits in screening for carotid artery stenosis in asymptomatic adults (SOR: B, multiple cohort studies); therefore, incidental radiographic carotid artery calcifications in asymptomatic patients should not prompt further testing.
What is the optimal frequency for dental checkups for children and adults?
EVIDENCE SUMMARY
A systematic review featured a single RCT (n=185) comparing the effect of a 12-month vs 24-month interval between dental visits on dental caries in low-risk 3- to 5-year-old children with primary teeth and young adults, ages 16 to 20 years, with permanent teeth.1 The outcomes of caries (ie, decayed, missing, filled surfaces increment) between the 12- and 24-month visits both in younger children (mean difference [MD]= -0.90; 95% confidence interval [CI], -1.96 to 0.16) and young adults (MD= -0.86; 95% CI, -1.75 to 0.03) did not differ.
Gingivitis: Not an issue when visits were delayed in healthy adults
Another systematic review (3 RCTs; N=836) evaluated the benefits associated with scaling and polishing in the prevention of gingivitis (primary outcome measure).2 One RCT (n=207) compared scaling and polishing at 6- and 12-month intervals to no treatment for 24 months in adults with healthy dental histories. There was no difference in the percentage of index teeth with bleeding in the 6-month or 12-month treatment groups compared to the group that received no treatment for 24 months (MD= -2%; 95% CI, -10% to 6% and MD= -1%; 95% CI, -9% to 7%, respectively).
2 visits/year prevents tooth loss in high-risk patients
A retrospective cohort study (N=5117) using 16 years of data evaluated the association between one or 2 preventive dental visits per year and tooth extraction events in adults at low risk and those at high risk for progressive periodontitis.3 Those at high risk had at least one of the following risk factors: smoking, diabetes, or interleukin-1 genotype. Low-risk patients had no difference in tooth loss with one visit compared to 2 visits annually (absolute risk reduction [ARR]=2.6%; 95% CI, 0.5%-5.8%; P=.092); however, high-risk patients had fewer events with 2 annual visits (number needed to treat [NNT]=19; ARR 5.2%; 95% CI, 1.8%-8.4%; P=.002).
Visits before age 3 likely benefit only those at high risk
A systematic review of 4 retrospective cohort studies (N=77,291) analyzed the impact of early preventive dental visits (EPDV) on the frequency of future preventive and non-preventive dental visits and related expenditures using data from insurance claims and a kindergarten state dental registry.4 One study (n=11,394) used dental disease status at kindergarten (defined as the count of decayed, missing [molar teeth only], and filled primary teeth) as an outcome measure. Children who received EPDV before age 24 months had a comparable number of caries to those who had EPDV at 24 to 36 months. The authors concluded that EPDV before age 3 years is likely to benefit only children at high risk, and that evidence for a first dental visit by age one year is weak.
RECOMMENDATIONS
The National Institute for Health and Care Excellence recommends preventive dental visit intervals based on individual risk (12 months as the longest interval under age 18 years and 24 months as the longest interval for those 18 years and older at low risk).5 The American Dental Association recommends preventive dental visits at intervals determined by individual risk.6 The American Academy of Pediatric Dentistry recommends a first exam by age one year and preventive dental visits every 6 months through adolescence or as indicated by individual risk.7 The US Preventive Services Task Force states there is insufficient evidence to recommend routine dental screening by primary care physicians in children up to age 5 years.8
1. Riley P, Worthington HV, Clarkson JE, et al. Recall intervals for oral health in primary care patients. Cochrane Database Syst Rev. 2013;12:CD004346.
2. Worthington HV, Clarkson JE, Bryan G, et al. Routine scale and polish for periodontal health in adults. Cochrane Database Syst Rev. 2013;11:CD004625.
3. Giannobile WV, Braun TM, Caplis AK, et al. Patient stratification for preventive care in dentistry. J Dent Res. 2013;92:694-701.
4. Bhaskar V, McGraw KA, Divaris K. The importance of preventive dental visits from a young age: systematic review and current perspectives. Clin Cosmetic Investig Dent. 2014;6:21-27.
5. National Institute for Health and Care Excellence. Dental checks: intervals between oral health reviews. Available at: https://www.nice.org.uk/guidance/cg19. Accessed March 22, 2016.
6. American Dental Association. American Dental Association Statement on Regular Dental Visits. 2013. Available at: http://www.ada.org/en/press-room/news-releases/2013-archive/june/american-dental-association-statement-on-regular-dental-visits. Accessed March 22, 2016.
7. American Academy of Pediatric Dentistry. Guideline on periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children and adolescents. Pediatr Dent. 2013;35:E148-E156.
8. Moyer VA; US Preventive Services Task Force. Prevention of dental caries in children from birth through age 5 years: US Preventive Services Task Force recommendation statement. Pediatrics. 2014;133:1102-1111.
EVIDENCE SUMMARY
A systematic review featured a single RCT (n=185) comparing the effect of a 12-month vs 24-month interval between dental visits on dental caries in low-risk 3- to 5-year-old children with primary teeth and young adults, ages 16 to 20 years, with permanent teeth.1 The outcomes of caries (ie, decayed, missing, filled surfaces increment) between the 12- and 24-month visits both in younger children (mean difference [MD]= -0.90; 95% confidence interval [CI], -1.96 to 0.16) and young adults (MD= -0.86; 95% CI, -1.75 to 0.03) did not differ.
Gingivitis: Not an issue when visits were delayed in healthy adults
Another systematic review (3 RCTs; N=836) evaluated the benefits associated with scaling and polishing in the prevention of gingivitis (primary outcome measure).2 One RCT (n=207) compared scaling and polishing at 6- and 12-month intervals to no treatment for 24 months in adults with healthy dental histories. There was no difference in the percentage of index teeth with bleeding in the 6-month or 12-month treatment groups compared to the group that received no treatment for 24 months (MD= -2%; 95% CI, -10% to 6% and MD= -1%; 95% CI, -9% to 7%, respectively).
2 visits/year prevents tooth loss in high-risk patients
A retrospective cohort study (N=5117) using 16 years of data evaluated the association between one or 2 preventive dental visits per year and tooth extraction events in adults at low risk and those at high risk for progressive periodontitis.3 Those at high risk had at least one of the following risk factors: smoking, diabetes, or interleukin-1 genotype. Low-risk patients had no difference in tooth loss with one visit compared to 2 visits annually (absolute risk reduction [ARR]=2.6%; 95% CI, 0.5%-5.8%; P=.092); however, high-risk patients had fewer events with 2 annual visits (number needed to treat [NNT]=19; ARR 5.2%; 95% CI, 1.8%-8.4%; P=.002).
Visits before age 3 likely benefit only those at high risk
A systematic review of 4 retrospective cohort studies (N=77,291) analyzed the impact of early preventive dental visits (EPDV) on the frequency of future preventive and non-preventive dental visits and related expenditures using data from insurance claims and a kindergarten state dental registry.4 One study (n=11,394) used dental disease status at kindergarten (defined as the count of decayed, missing [molar teeth only], and filled primary teeth) as an outcome measure. Children who received EPDV before age 24 months had a comparable number of caries to those who had EPDV at 24 to 36 months. The authors concluded that EPDV before age 3 years is likely to benefit only children at high risk, and that evidence for a first dental visit by age one year is weak.
RECOMMENDATIONS
The National Institute for Health and Care Excellence recommends preventive dental visit intervals based on individual risk (12 months as the longest interval under age 18 years and 24 months as the longest interval for those 18 years and older at low risk).5 The American Dental Association recommends preventive dental visits at intervals determined by individual risk.6 The American Academy of Pediatric Dentistry recommends a first exam by age one year and preventive dental visits every 6 months through adolescence or as indicated by individual risk.7 The US Preventive Services Task Force states there is insufficient evidence to recommend routine dental screening by primary care physicians in children up to age 5 years.8
EVIDENCE SUMMARY
A systematic review featured a single RCT (n=185) comparing the effect of a 12-month vs 24-month interval between dental visits on dental caries in low-risk 3- to 5-year-old children with primary teeth and young adults, ages 16 to 20 years, with permanent teeth.1 The outcomes of caries (ie, decayed, missing, filled surfaces increment) between the 12- and 24-month visits both in younger children (mean difference [MD]= -0.90; 95% confidence interval [CI], -1.96 to 0.16) and young adults (MD= -0.86; 95% CI, -1.75 to 0.03) did not differ.
Gingivitis: Not an issue when visits were delayed in healthy adults
Another systematic review (3 RCTs; N=836) evaluated the benefits associated with scaling and polishing in the prevention of gingivitis (primary outcome measure).2 One RCT (n=207) compared scaling and polishing at 6- and 12-month intervals to no treatment for 24 months in adults with healthy dental histories. There was no difference in the percentage of index teeth with bleeding in the 6-month or 12-month treatment groups compared to the group that received no treatment for 24 months (MD= -2%; 95% CI, -10% to 6% and MD= -1%; 95% CI, -9% to 7%, respectively).
2 visits/year prevents tooth loss in high-risk patients
A retrospective cohort study (N=5117) using 16 years of data evaluated the association between one or 2 preventive dental visits per year and tooth extraction events in adults at low risk and those at high risk for progressive periodontitis.3 Those at high risk had at least one of the following risk factors: smoking, diabetes, or interleukin-1 genotype. Low-risk patients had no difference in tooth loss with one visit compared to 2 visits annually (absolute risk reduction [ARR]=2.6%; 95% CI, 0.5%-5.8%; P=.092); however, high-risk patients had fewer events with 2 annual visits (number needed to treat [NNT]=19; ARR 5.2%; 95% CI, 1.8%-8.4%; P=.002).
Visits before age 3 likely benefit only those at high risk
A systematic review of 4 retrospective cohort studies (N=77,291) analyzed the impact of early preventive dental visits (EPDV) on the frequency of future preventive and non-preventive dental visits and related expenditures using data from insurance claims and a kindergarten state dental registry.4 One study (n=11,394) used dental disease status at kindergarten (defined as the count of decayed, missing [molar teeth only], and filled primary teeth) as an outcome measure. Children who received EPDV before age 24 months had a comparable number of caries to those who had EPDV at 24 to 36 months. The authors concluded that EPDV before age 3 years is likely to benefit only children at high risk, and that evidence for a first dental visit by age one year is weak.
RECOMMENDATIONS
The National Institute for Health and Care Excellence recommends preventive dental visit intervals based on individual risk (12 months as the longest interval under age 18 years and 24 months as the longest interval for those 18 years and older at low risk).5 The American Dental Association recommends preventive dental visits at intervals determined by individual risk.6 The American Academy of Pediatric Dentistry recommends a first exam by age one year and preventive dental visits every 6 months through adolescence or as indicated by individual risk.7 The US Preventive Services Task Force states there is insufficient evidence to recommend routine dental screening by primary care physicians in children up to age 5 years.8
1. Riley P, Worthington HV, Clarkson JE, et al. Recall intervals for oral health in primary care patients. Cochrane Database Syst Rev. 2013;12:CD004346.
2. Worthington HV, Clarkson JE, Bryan G, et al. Routine scale and polish for periodontal health in adults. Cochrane Database Syst Rev. 2013;11:CD004625.
3. Giannobile WV, Braun TM, Caplis AK, et al. Patient stratification for preventive care in dentistry. J Dent Res. 2013;92:694-701.
4. Bhaskar V, McGraw KA, Divaris K. The importance of preventive dental visits from a young age: systematic review and current perspectives. Clin Cosmetic Investig Dent. 2014;6:21-27.
5. National Institute for Health and Care Excellence. Dental checks: intervals between oral health reviews. Available at: https://www.nice.org.uk/guidance/cg19. Accessed March 22, 2016.
6. American Dental Association. American Dental Association Statement on Regular Dental Visits. 2013. Available at: http://www.ada.org/en/press-room/news-releases/2013-archive/june/american-dental-association-statement-on-regular-dental-visits. Accessed March 22, 2016.
7. American Academy of Pediatric Dentistry. Guideline on periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children and adolescents. Pediatr Dent. 2013;35:E148-E156.
8. Moyer VA; US Preventive Services Task Force. Prevention of dental caries in children from birth through age 5 years: US Preventive Services Task Force recommendation statement. Pediatrics. 2014;133:1102-1111.
1. Riley P, Worthington HV, Clarkson JE, et al. Recall intervals for oral health in primary care patients. Cochrane Database Syst Rev. 2013;12:CD004346.
2. Worthington HV, Clarkson JE, Bryan G, et al. Routine scale and polish for periodontal health in adults. Cochrane Database Syst Rev. 2013;11:CD004625.
3. Giannobile WV, Braun TM, Caplis AK, et al. Patient stratification for preventive care in dentistry. J Dent Res. 2013;92:694-701.
4. Bhaskar V, McGraw KA, Divaris K. The importance of preventive dental visits from a young age: systematic review and current perspectives. Clin Cosmetic Investig Dent. 2014;6:21-27.
5. National Institute for Health and Care Excellence. Dental checks: intervals between oral health reviews. Available at: https://www.nice.org.uk/guidance/cg19. Accessed March 22, 2016.
6. American Dental Association. American Dental Association Statement on Regular Dental Visits. 2013. Available at: http://www.ada.org/en/press-room/news-releases/2013-archive/june/american-dental-association-statement-on-regular-dental-visits. Accessed March 22, 2016.
7. American Academy of Pediatric Dentistry. Guideline on periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children and adolescents. Pediatr Dent. 2013;35:E148-E156.
8. Moyer VA; US Preventive Services Task Force. Prevention of dental caries in children from birth through age 5 years: US Preventive Services Task Force recommendation statement. Pediatrics. 2014;133:1102-1111.
Evidence-based answers from the Family Physicians Inquiries Network
EVIDENCE-BASED ANSWER:
It is unclear, but studies suggest that it should be based largely on individual risk. The American Academy of Pediatric Dentistry recommends a 6-month interval for preventive dental visits (strength of recommendation [SOR]: C, expert opinion), but a 24-month interval does not result in an increased incidence of dental caries in healthy children and young adults or increased incidence of gingivitis in healthy adults (SOR: B, a single randomized controlled trial [RCT]). In adults with risk factors (eg, smoking or diabetes), visits at 6-month intervals are associated with a lower incidence of tooth loss (SOR: C, a retrospective cohort study). Children with risk factors (eg, caries) may benefit from a first dental visit by age 3 years (SOR: C, a retrospective cohort study).
